| NPI | 1114077682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA Chiro005030) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 5030) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-03-09 |